PCR‐based detection of Aspergillus fumigatus and absence of azole resistance due to TR34/L98H in a french multicenter cohort of 137 patients with fungal rhinosinusitis

SummaryBackground Fungal rhinosinusitis has a worldwide distribution, comprises distinct clinical entities but is mostly due to Aspergillus among which A. fumigatus plays a major role in European countries. Although, there is accumulating evidence for the emergence of environmentally acquired-azole resistance in A. fumigatus (such as TR34/L98H) in various clinical settings, there is few data for patients with fungal rhinosinusitis. Objectives To investigate the prevalence of A. fumigatus azole resistance due to TR34/L98H in a multicenter cohort of patients with fungal rhinosinusitis. Patients/methods 137 patients with fungal rhinosinusitis admitted between 2002 and 2016 at four French medical centers were retrospectively enrolled. Clinical and mycological findings were collected. Aspergillus fumigatus and the TR34/L98H alteration conferring azole resistance were investigated directly from clinical samples using the commercial CE-IVD marked MycoGENIE® Aspergillus fumigatus Real-Time PCR assay. Results/Conclusions Fungal ball was the more frequent clinical form (n=118). Despite the presence of fungal hyphae at direct microscopic examination, mycological cultures remained negative for 83 out of the 137 patients (60.6%). The PCR assay proved to be useful allowing the identification of A. fumigatus and etiological diagnosis in 106 patients (77.4%) compared with 44 patients (32.1%) when using culture as the reference method. Importantly, neither TR34 nor L98H alterations were evidenced. This article is protected by copyright. All rights reserved.